CAJ | 학술논문

目的：探讨右旋美托咪定对全麻下行腹腔镜肠肿瘤根治术老年患者术后谵妄及术后褪黑素（ MT）血浆浓度的影响。方法择期在全麻下行腹腔镜肠肿瘤根治术老年患者90例，采用随机数字表法，将患者分为三组（ n＝30）：中等剂量右旋美托咪定（ DEX）组（ D1组），低剂量DEX组（ D2组），对照组（ C组），采用放射免疫法检测血浆褪黑素浓度，观察并记录各组患者不同时点 HR、MAP、SpO2、NarcotrendNT值及术中丙泊酚用量，Narcotrend指数达D级（50±5）插管时丙泊酚血浆浓度，术后24 h内谵妄的发生情况、麻醉时间、麻醉苏醒时间、苏醒期躁动情况及Ramsay镇静评分。结果 DEX组（ D1、D2组）患者苏醒期躁动发生率及术后24 h内谵妄的发生率明显降低（P＜0．05）。术中丙泊酚用量及插管时丙泊酚血浆浓度比较，DEX组比对照组（ C组）显著减少（ P＜0．05）。与对照组相比，DEX组术前术后血浆褪黑素浓度变化明显降低（P＜0．01），DEX组患者Ramsay镇静评分显著高于C组患者（P＜0．05）。结论右旋美托咪定降低全麻下老年腹腔镜肠肿瘤根治术术后谵妄的发生，术后其可能与血浆褪黑素（ MT）浓度的变化相关。
목적：탐토우선미탁미정대전마하행복강경장종류근치술노년환자술후섬망급술후퇴흑소（ MT）혈장농도적영향。방법택기재전마하행복강경장종류근치술노년환자90례，채용수궤수자표법，장환자분위삼조（ n＝30）：중등제량우선미탁미정（ DEX）조（ D1조），저제량DEX조（ D2조），대조조（ C조），채용방사면역법검측혈장퇴흑소농도，관찰병기록각조환자불동시점 HR、MAP、SpO2、NarcotrendNT치급술중병박분용량，Narcotrend지수체D급（50±5）삽관시병박분혈장농도，술후24 h내섬망적발생정황、마취시간、마취소성시간、소성기조동정황급Ramsay진정평분。결과 DEX조（ D1、D2조）환자소성기조동발생솔급술후24 h내섬망적발생솔명현강저（P＜0．05）。술중병박분용량급삽관시병박분혈장농도비교，DEX조비대조조（ C조）현저감소（ P＜0．05）。여대조조상비，DEX조술전술후혈장퇴흑소농도변화명현강저（P＜0．01），DEX조환자Ramsay진정평분현저고우C조환자（P＜0．05）。결론우선미탁미정강저전마하노년복강경장종류근치술술후섬망적발생，술후기가능여혈장퇴흑소（ MT）농도적변화상관。
Objective We were to observe the influence of DEX on postoperative melatonin concentration in plasma and the incidence of postoperative delirium in elderly patients undergoing laparoscopic bowel cancer radical surgery under general anesthesia.Methods A total of 90 elderly patients scheduled to receive laparoscopic bowel cancer radical surgery under general anesthesia were randomly divided into 3 groups ( n=30):medium dose of dexmedetomidine (group D1), low dose of dexmedetomidine (group D2) and control group (group C).The plasma concentration of melatonin was detected by ria method.HR,MAP,SPO2 and narcotrend NT index were recorded at different time point. Intraoperative propofol consumption, plasma concentrations of propofol at intubation with Narcotrend NT index ( 50 +5 ) , postoperative delirium rating scale within 24h,anesthesia time,agitation conditions of awakening period and ramsay sedation scores were documented. Results Patients in groupD1 and groupD2 had lower postoperative delirium rating scale within 24h and agitation rate of awakening period (P<0.05) and had lower propofol consumption and plasma concentration of propofol during intubation (P<0.05).Compared with patients in control group,the changes of plasma concentrations of melatonin had lower during the preoperative and postoperative in groupD1 and group D2(P<0.01).Patients in group D1 and D2 had significantly higher ramsay sedation score (P<0.05).Conclusions Dexmedetomidine can prevent postoperative delirium in elderly patients received laparoscopic bowel cancer radical surgery under general anesthesia,which may associate with the changes of plasma concentration of melatonin ( MT) .